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EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.. 2011 -27 <br />CERTIFICATE OF INSURANCE <br />COVERAGE EXCLUDED FOR NOMINEE EVENTS SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br />SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER <br />PUBLIC ENTITY (ADDITIONAL INSURED) <br />Alliant Insurance Services, Inc. in conjunction with <br />City of Santa Ana <br />Apex Insurance Services <br />20 Civic Center Plaza <br />P" O. Box 6450 <br />Santa Ana, CA 92701 N -20'1 7 -081 <br />Newport Beach, CA 92658 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOLDER): <br />EVENT INFORMATION: <br />Daniel Ramirez <br />TYPE: Dance <br />13901 Fernwood Drive <br />DATE(S): Mav 10. 2011 — December 31. 2011 <br />Garden Grove, CA 92843 <br />LOCATION: Jerome Center <br />*Liquor Liability Yes Q No <br />* *Li uor Liabili after 12 am ends before 2 am <br />This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy <br />period indicated. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This <br />certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy listed and it does not <br />constitute a contract between the insurance carrier, authorized representative, producer and certificate holder. The insurance <br />described herein is subject to all the terms, exclusions and conditions of such policy(ies). <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 11SEP1000001 <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2011 EXPIRATION: JANUARY 1, 2012 <br />COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />DEDUCTIBLE: NONE <br />General Aggregate Limit $ 2,000,000 <br />Products � Completed Operations 1,OOQ000 <br />Personal 8c Advertising Injury 1,000,000 <br />Each Occurrence Limit ],000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />Liquor Liability (If purchased) 1,000,000 <br />The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not apply to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in [hat premises. <br />OTHER ADDITIONAL INSUREDS <br />Maryella Ramirez <br />Denys Diaz <br />CANCELLATION- Should the above described policy be cancelled before [he expiration date thereof, notice will be delivered in accordance with the policy <br />rovisions. Ev ef%rt will be made to deliver 30 da s written notice to the certi£cate holder and additional insureds listed. <br />AUTHORIZED REPRESENTATIVE: ���� %�"`"-""�� ,t�v�R(7V�:1, .r1S "TV I�Oh'M <br />DATE ISSUED: May 10. 2011 by Briza Morales ��"e_P�� -c-�_- <br />�IIYtt�ca'�� <br />Assistant City Attorney <br />